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Middle East respiratory syndrome coronavirus (MERS-CoV) infection made notifiable

MERS-CoV became a notifiable infectious disease in Western Australia, as of Wednesday 2 July, following publication of a notice in the Government Gazette the previous day.

An accompanying notice designated MERS-CoV a “dangerous infectious disease”, as defined in the Health Act 1911. The latter designation allows the use of formal powers – as outlined in section 251 of the Act – to order public health disease control measures such as isolation, quarantine, and testing, should they be necessary.

Attending doctors and pathology laboratories are now required by law to notify the WA Department of Health of persons considered on clinical and epidemiological grounds, or as a result of testing, to have MERS-CoV infection.

Background

MERS-CoV belongs to the same family of viruses as the Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) that emerged in southern China in late 2002 and subsequently caused outbreaks of serious respiratory disease in several countries, along with considerable community anxiety and disruption to affected economies and international travel. MERS-CoV does not appear to be as easily transmitted from person-to-person as was SARS-CoV, but understanding of the source of MERS-CoV and its transmissibility remains limited.

MERS-CoV has been recognised as causing severe respiratory and associated systemic disease in humans in countries of the Arabian Peninsula and surrounding area since April 2012, with the highest incidence in Saudi Arabia and the United Arab Emirates (UAE). It has a mortality rate of around 35% in diagnosed cases, with middle-aged and elderly people with an underlying disease being particularly susceptible. The disease has shown a propensity for transmission within households and in healthcare facilities to other patients and healthcare workers.

The rate of transmission of MERS-CoV increased significantly in April and May, especially in Saudi Arabia, but has declined since. To date, affected countries in the Middle East have included Saudi Arabia, the UAE, Jordan, Qatar, Iran, Kuwait, Oman, Lebanon and Yemen. Other countries reporting cases in travellers from the Middle East region have included Algeria, Egypt, Tunisia, France, Germany, Greece, Italy, the Netherlands, the United Kingdom, Malaysia, the Philippines and the USA.

No cases of MERS-CoV have been diagnosed in Australia to date, although many travellers from the Middle East region with respiratory diseases have been investigated. It seems inevitable that cases will eventually be confirmed in Australia, given the frequency of travel from the Middle East region, including pilgrims returning from the Hajj and Umrah.

Case definition

Doctors are advised to consider testing for and notification of MERS-CoV in persons who meet the following criteria for a suspect case:

Suspect case (patient under investigation)

A person with an acute respiratory infection, which may include history of fever or measured fever (≥ 38°C) and cough, AND

  • evidence of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress Syndrome (ARDS)), based on clinical or radiological evidence of consolidation, AND
  • residence in or history of travel to Middle Eastern countries where MERS-CoV is believed to be circulating, in the 14 days before onset of illness (OR close contact with a symptomatic PROBABLE or CONFIRMED case within 14 days before onset of illness), AND
  • not already explained by any other infection or aetiology, including all clinically indicated tests for community-acquired pneumonia according to local management guidelines. It is not necessary to wait for all test results for other pathogens before testing for MERS-CoV.

Probable and confirmed cases are currently defined as follows:

Probable case

A person fitting the definition of a “suspect case” but with absent (e.g. patient has died or no specimens remain) or inconclusive (e.g. negative on a single inadequate specimen, or positive on a single PCR target) testing for MERS-CoV, AND

  • close contact with a symptomatic laboratory-confirmed case.

Confirmed case

A person with laboratory confirmation of infection with MERS-CoV. PCR testing for MERS-CoV is available at PathWest.

Notification  

Please contact the on-call Public Health Physician at the Communicable Disease Control Directorate (CDCD) urgently to notify any suspect, probable or confirmed cases (telephone 9388 4801 during office hours, or 9328 0553 after hours).

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